Deep Multifidus Stiffness In Athletes | Fixing Chronic Low Back Pain With Physiotherapy

 Chronic low back pain (CLBP) is a common problem among athletes, often leading to reduced performance, missed training sessions, and even prolonged time away from competition. One of the lesser-known but critical contributors to CLBP is increased stiffness in the deep lumbar multifidus (LM) muscle. This deep stabilizer of the spine is essential for segmental control, and when it becomes excessively stiff, it can perpetuate pain and dysfunction.

      Physiotherapy plays a central role in both preventing and treating LM stiffness, ensuring athletes can perform at their best while minimizing the risk of recurrent back injuries.

 

What is the Deep Lumbar Multifidus Muscle and Why is it Important?

The lumbar multifidus muscle is a series of small but powerful stabilizers located on either side of the vertebral column. It has two primary layers:

1. Superficial fibers: Span multiple vertebral levels and assist with gross trunk extension and posture.
2. Deep fibers: Attach segmentally from one vertebra to the next, providing precise control of intersegmental movement.

For athletes, especially those involved in sports requiring dynamic trunk control (e.g., cricket, football, gymnastics, weightlifting), the deep LM muscle is critical for absorbing load, maintaining spinal alignment, and preventing excessive motion that could lead to injury.

 

What Does Increased Stiffness Mean?

Muscle stiffness refers to the resistance a muscle offers when being stretched. While some stiffness is necessary for stability, excessive stiffness in the deep LM muscle can be problematic.

1. Structural stiffness: Chronic low back pain can lead to changes in muscle tissue, including fibrosis, fatty infiltration, and altered muscle fiber composition.
2. Neuromuscular stiffness: Ongoing pain can cause the nervous system to increase muscle tone as a protective mechanism, leading to prolonged tension.

In athletes, this maladaptive stiffness can reduce the LM’s ability to respond dynamically during training and competition, causing further discomfort and performance deficits.

 

Why Does LM Stiffness Develop in Athletes with CLBP?

Several mechanisms contribute to increased stiffness in athletes:

1. Pain-induced muscle guarding – Pain triggers the nervous system to keep the muscle contracted to “protect” the spine. Over time, this becomes habitual, leading to chronic stiffness.
2. Altered motor control – Chronic pain often disrupts the normal activation timing of the LM, causing it to remain engaged even when it shouldn’t.
3. Repetitive microtrauma – High training volumes, poor technique, or repetitive trunk extension/rotation can create micro-injuries, resulting in scar tissue and increased stiffness.
4. Deconditioning – Athletes who avoid certain movements due to pain may lose LM strength and endurance, with stiffness arising as a compensatory mechanism.

 

Consequences of Increased LM Stiffness

Excessive stiffness in the deep LM muscle can have multiple effects on spinal function and athletic performance:

1. Reduced spinal segmental mobility, limiting natural movement patterns.
2. Abnormal load transfer, increasing stress on discs, joints, and ligaments.
3. Persistent pain cycle, where pain leads to stiffness and stiffness perpetuates pain.

4. Compensatory movement patterns, leading to secondary injuries in the hips, pelvis, or thoracic spine.

 

How Physiotherapy Helps: Prevention and Treatment

Physiotherapists play a pivotal role in addressing increased LM stiffness through early detection, targeted interventions, and long-term prevention strategies.

1. Accurate Assessment

a. Palpation and manual testing: Skilled physiotherapists can identify increased tone and tenderness in the LM.

b. Motor control assessments: Identify poor LM activation patterns that contribute to stiffness and pain.

 

2. Pain Relief and Muscle Relaxation

Before retraining the LM, physiotherapists aim to reduce pain and muscle guarding:

a. Manual therapy: Soft tissue release, joint mobilizations, and trigger point therapy can reduce stiffness.

b. Modalities: Techniques such as dry needling, tens, Laser, Shockwave, Cret therapy, therapeutic ultrasound, and heat therapy help decrease tone.

c. Education: Teaching athletes to avoid maladaptive postures and movements that perpetuate stiffness.

 

3. Restoring LM Activation

Once pain is managed, physiotherapists guide athletes through specific activation exercises:

a. Prone abdominal draw-in maneuver: Teaches isolated activation of the deep LM fibers.

b. Quadruped and functional stabilization exercises: Progressively challenge the LM while ensuring proper motor control.

c. Biofeedback: Real-time ultrasound or tactile feedback ensures correct muscle recruitment.

 

4. Improving Mobility and Motor Control

Segmental mobility drills help restore flexibility in the lumbar spine.

a. Dynamic stability training integrates LM activation with global core muscles (e.g., transversus abdominis, obliques) to optimize trunk control.

b. Functional retraining ensures improved spinal stability during sport-specific movements such as jumping, twisting, and sprinting.

 

5. Load Management and Long-Term Prevention

Physiotherapists also focus on reducing re-injury risk by:

a. Educating athletes on optimal training loads and recovery strategies.

b. Correcting biomechanical issues that place undue stress on the lumbar spine.

c. Incorporating regular core stabilization and flexibility programs into training routines.

 

Why Early Physiotherapy Intervention Matters?

Early intervention by a physiotherapist can break the pain-stiffness cycle before it becomes chronic. By addressing both the pain and the underlying dysfunction, physiotherapy not only reduces stiffness in the LM but also improves spinal mechanics, allowing athletes to return to sport stronger and more resilient.

Early Crepitus: What It Means And How Physiotherapy Can Help?

 Have you ever bent your knees or moved your shoulders and heard a crackling or grinding sound? This sensation, known as crepitus, is fairly common and often harmless. But when it begins to appear early — especially in younger individuals or athletes — it may signal underlying biomechanical or joint-related issues that need attention. While crepitus is not always painful, it can be an early indicator of joint stress or degeneration. Fortunately, physiotherapy plays a critical role in identifying, managing, and preventing its progression.

 

What Is Crepitus?

Crepitus refers to a grating, crackling, or popping sound or sensation that occurs when a joint moves. It can be felt or heard during activities like walking, squatting, lifting your arm, or turning your neck. It is commonly experienced in joints such as:

• Knees
• Shoulders
• Hips
• Neck
• Jaw (temporomandibular joint)

There are three main causes of crepitus:

1. Air bubbles in the synovial fluid, which can collapse or burst during movement (harmless and common).
2. Tendon or ligament movement over bony surfaces or tissues.
3. Degenerative changes, where rough cartilage surfaces grind against each other — often seen in arthritis.
When crepitus begins to occur early in life, without significant trauma or disease, it's known as early crepitus and may be linked to poor biomechanics, muscle imbalances, or joint instability.

 

Is Early Crepitus a Cause for Concern?

Not always. In many cases, early crepitus is painless and harmless, especially when there is no swelling, locking, or restriction in motion. However, when accompanied by:

• Pain
• Swelling
• Joint stiffness
• Recurrent clicking or locking
• Reduced function or instability

It can indicate underlying problems such as early joint degeneration, muscle weakness, or postural issues. Early crepitus is especially relevant in younger individuals or athletes, where repetitive strain, overuse, or training errors can lead to joint wear over time. Addressing it early is key to preventing long-term joint damage.

 

Common Conditions Associated with Early Crepitus

1. Patellofemoral Pain Syndrome (PFPS) – crepitus in the front of the knee due to improper tracking of the kneecap.
2. Shoulder Impingement or Rotator Cuff Dysfunction – leading to clicking and catching sensations.
3. Early Osteoarthritis – where joint cartilage begins to wear down.
4. Meniscal Injuries or Ligament Instability – in the knee joint.

 

Role of Physiotherapy in Managing Early Crepitus

Physiotherapy is the frontline non-invasive approach to managing crepitus, particularly when it appears early. The aim is not just symptom relief, but addressing the root cause and restoring joint mechanics.

1. Detailed Assessment and Diagnosis

Physiotherapists begin with a comprehensive assessment:

1. Identifying which joint is affected
2. Observing posture and movement patterns
3. Checking for muscle imbalances or tightness
4. Performing functional and orthopedic tests

Understanding the cause of crepitus—whether mechanical, muscular, or degenerative—is crucial for effective treatment.

 

2. Strengthening Weak Muscles

One of the most common causes of crepitus is muscle imbalance. Weak muscles fail to stabilize joints properly, leading to abnormal movement and wear.

1. Quadriceps and glutes in knee crepitus
2. Rotator cuff and scapular stabilizers in shoulder crepitus
3. Core and hip muscles in spinal and pelvic-related crepitus

Physiotherapists prescribe targeted strengthening exercises to improve joint control and reduce noise-producing movements.

 

3. Stretching and Flexibility

Tight muscles can pull joints out of alignment. For example, tight iliotibial band or hip flexors may affect knee tracking, while tight pectorals or upper traps can alter shoulder mechanics. A physiotherapy program includes dynamic and static stretches to improve flexibility and restore normal joint mechanics.

 

4. Manual Therapy

Hands-on techniques such as:

1. Joint mobilizations
2. Soft tissue release
3. Myofascial release

…are used to reduce joint stiffness, improve range of motion, and correct alignment issues that may be causing crepitus.

  

5. Postural Correction

Poor posture, especially in modern sedentary lifestyles, can place joints under continuous abnormal stress. Rounded shoulders, forward head posture, or collapsed arches in the feet can all contribute to early joint degeneration and crepitus.

Physiotherapists correct posture through:

1. Ergonomic education

2. Postural exercises

3. Awareness techniques

 

6. Movement Re-education

Physiotherapy also focuses on teaching proper movement patterns, especially in athletes or active individuals. Jumping, squatting, lifting, or running with faulty mechanics increases joint stress.

Through functional training, patients learn to move more efficiently, reducing unnecessary joint pressure and minimizing crepitus.

 

7. Modalities for Pain Relief (if needed)

In cases where crepitus is painful, physiotherapists may use:

1. Ultrasound therapy
2. TENS (Transcutaneous Electrical Nerve Stimulation)
3. Kinesiology taping
4. Cryotherapy or heat therapy

These help reduce inflammation and discomfort while rehabilitation continues.

 

Preventive Role of Physiotherapy

Even in the absence of pain, early crepitus can be a warning sign. Physiotherapy plays a vital role in preventing progression to degenerative joint changes by:

• Educating patients on joint care
• Promoting healthy movement habits
• Reducing risk of injury through conditioning
• Regular monitoring and early intervention

Early crepitus doesn’t always signal damage, but it should never be ignored — especially when persistent, painful, or affecting function. Rather than waiting for symptoms to worsen, seeking help from a qualified physiotherapist can make all the difference. Through assessment, exercise, manual therapy, and education, physiotherapy offers a proactive, effective path to manage crepitus, preserve joint health, and enhance quality of life.

Exercise-induced Leg Pain | How Physiotherapy Can Help You Get Back On Track

 Exercise is essential for maintaining good health, but sometimes it can lead to unwanted discomfort — particularly leg pain. Whether you're an athlete, a weekend warrior, or someone just beginning a new fitness routine, leg pain triggered by physical activity is a common issue. Known as Exercise-Induced Leg Pain (EILP), this condition can interfere with performance, delay progress, and even lead to long-term injury if left unaddressed.

   Fortunately, physiotherapy offers a proven, non-invasive way to manage, treat, and even prevent exercise-induced leg pain. In this blog, we’ll explore the common causes of EILP, how physiotherapists diagnose it, and the variety of treatments they use to help patients recover and return to activity pain-free.

 

What is Exercise-Induced Leg Pain?

Exercise-Induced Leg Pain refers to discomfort or pain in the leg that arises during or after physical activity. It can affect different areas of the leg — from the hips to the feet — and may involve muscles, tendons, bones, or joints. The pain can range from a dull ache to a sharp or throbbing sensation and may be temporary or persistent depending on the underlying cause.

 

Common Causes of Exercise-Induced Leg Pain

Understanding the root cause is key to effective treatment. Some of the most common causes of EILP include:

1. Shin Splints (Medial Tibial Stress Syndrome)

A frequent condition in runners and dancers, shin splints result from overuse of the shinbone and surrounding tissues. Pain typically occurs along the inner edge of the tibia and worsens with activity.

2. Delayed-Onset Muscle Soreness (DOMS)

DOMS causes muscle pain and stiffness 24–72 hours after intense or unfamiliar exercise. It is usually self-limiting but can be quite uncomfortable.

3. Muscle Strains

Overstretching or tearing of muscle fibers, often in the calves or hamstrings, can cause sudden or progressive leg pain.

4. Compartment Syndrome

This is a condition where pressure builds up within the muscles, limiting blood flow. Chronic exertional compartment syndrome (CECS) is triggered by exercise and relieved by rest.

5. Stress Fractures

Tiny cracks in bones, often the tibia or metatarsals, are caused by repetitive stress. Pain worsens with activity and improves with rest.

6. Tendinopathies

Inflammation or degeneration of tendons, such as the Achilles or patellar tendon, can lead to persistent leg pain with exercise.

 

How Physiotherapy Helps?

Physiotherapists are trained movement specialists who assess, diagnose, and treat musculoskeletal conditions like EILP. Their holistic approach focuses not just on relieving pain, but also on identifying and correcting the underlying dysfunction to prevent recurrence.

1. Accurate Assessment and Diagnosis

The first step is a detailed assessment. A physiotherapist will take a complete history, analyze movement patterns, evaluate strength and flexibility, and perform special tests to pinpoint the source of pain.

2. Pain Relief Techniques

·       Physiotherapists use a combination of manual therapy, electrotherapy (like TENS or ultrasound), ice/heat application, and soft tissue release techniques to reduce pain and inflammation.

3. Exercise Therapy

Targeted exercises are central to physiotherapy. These include:

·       Stretching tight muscles (e.g., calves, hamstrings)

·       Strengthening weak or imbalanced muscle groups

·       Neuromuscular re-education to improve coordination and balance

·       Gradual loading programs for conditions like tendinopathy or stress fractures

4. Biomechanical Correction

Abnormal movement patterns, poor posture, or improper footwear can contribute to leg pain. Physiotherapists analyze gait and running form and may recommend:

·       Orthotics or supportive footwear

·       Technique adjustments for sports or gym training

5. Return-to-Activity Planning

Your physiotherapist will guide you through a structured return-to-sport or exercise plan, ensuring you resume activity safely without triggering a relapse. This often includes graded exposure, activity modification, and cross-training options during recovery.

6. Education and Prevention

One of the greatest benefits of physiotherapy is the education it provides. You’ll learn how to:

·       Warm up and cool down effectively

·       Use proper technique

·       Recognize early warning signs

·       Cross-train and rest appropriately

·       Avoid overtraining and burnout.

 

When to Seek Physiotherapy?

You should consider seeing a physiotherapist if:

·       The leg pain persists for more than a few days

·       Pain worsens with activity or doesn’t improve with rest

·       There's swelling, numbness, or weakness in the leg

·       Your performance is being impacted

·       You’ve had recurrent leg pain with exercise

Exercise-induced leg pain can be frustrating, but it doesn't have to derail your fitness goals. With the right diagnosis and a personalized treatment plan, physiotherapy offers an effective solution to relieve pain, correct imbalances, and prevent future injury. Don’t let pain stop you — consult a physiotherapist and take the first step toward a stronger, pain-free return to the activities you love.

 

If you’d like help managing your exercise-related leg pain, consider booking a consultation with a qualified physiotherapist near you. Prevention, recovery, and performance — it all starts with the right movement.